Metylenblått hävde metforminassocierad laktacidos. Gav dramatiskt positiv effekt vid samtidig vasodilatorisk chock
Sammanfattning
A case of metformin-associated lactic acidosis and refractory vasodilatation treated with methylene blue and a literature review are presented. An adult on metformin treatment presented awake with shortness of breath. His BP was 160/100 mm Hg and pulse 100 bpm. Arterial blood gas analysis displayed pH 6.9, BE –30 and lactate 18 mmol/l. S-creatinine was 832 µmol/l. He suddenly deteriorated with a severe fall in blood pressure and was acutely intubated. At the ICU, echocardiography and hemodynamic measurements showed slightly decreased myocardial contractility and a very low systemic vascular resistance. Despite treatment with fluids, sodium bicarbonate, 3 vasopressor agents and CVVDH, the mean arterial pressure (MAP) was <50 mm Hg and lactate severely elevated for 20 hours. Methylene blue was then given as a bolus of 1.3 mg/kg iv followed by an infusion of 0.1 mg/kg/h. The effect was remarkable. Within 15 minutes, MAP increased by 15 mm Hg and lactate started to decrease. The patient recovered. Methylene blue may be effective in metformin-induced refractory vasodilatory shock.